Fatal scorpion sting in a child.

Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.

Prevalence and problems of foetal malnutrition in term babies at Wesley Guild Hospital, South Western Nigeria.

BACKGROUND: Up to two-thirds of low birth weight babies delivered in the developing countries are also small for gestational age (SGA). Since SGA is common in West Africa, FM is expected to be common in the region. OBJECTIVE: To determine the pattern, prevalence, and problems of FM among term babies delivered at a General Hospital. METHODS: Subjects were consecutive, live, singleton; full term neonates delivered at the hospital over eight months and were assessed within 24 hours of birth. Each baby was examined for evidence of FM using the Clinical Assessment of Nutritional Status Score (CANSCORE) described by Metcoff. The babies were classified into those with and without FM and the two groups compared. RESULTS: Four hundred and seventy three term singleton live born neonates consisting of 246 males and 227 (48%) females were assessed. Eighty-nine (52%). 18.8% of the 473 babies had FM. FM was commoner in SGA babies than AGAbabies (p < 0.001). A total of 47 (82.5%) of the 57 babies who were SGA had FM while 42 (10.6%) of 396 babies who were AGA had FM (p < 0.001) and none of the 20 LGA babies suffered from FM. Severe birth asphyxia, respiratory distress, meconium aspiration, hypoglycaemia, high haematocrit and hypoalbuminaemia were significantly commoner in babies with FM. Infants with FM had significantly higher mortality and neurological sequelae in the first month of life. CONCLUSION: FM is a major health problem in Nigeria with considerable morbidity and mortality. Using CANSCORE, the clinician can diagnose cases of FM which may be missed by using intrauterine growth chart.

Trace element status and early physical growth of exclusively breastfed normal and asphyxiated Nigerian babies.

Serial anthropometry and assay of plasma iron (Fe), zinc (Zn) and copper (Cu) were done on 72 babies with birth asphyxia during the first six months of life to assess the pattern of their physical growth and trace element status, respectively. Eighty-seven non-asphyxiated babies served as controls. The mothers of babies in both groups also had their plasma assayed for Fe, Zn and Cu immediately following delivery. Asphyxiated babies were lighter than non-asphyxiated controls during the first two months of life and they also had smaller mean occipito-frontal circumference at birth. While Fe, Zn and Cu status was generally comparable in both groups, the newborn Cu concentrations were very low compared with earlier reports. No baby showed any overt signs of trace element deficiency.

A prevalence survey of skin diseases in Nigerian children.

A prevalence survey of 5001 Nigerian children aged 0-12 years seen at the Urban Comprehensive Health Centre, Ile-Ife, Nigeria between July 1995 and June 1996 revealed that 492 children (9.8%) had dermatological conditions. Tinea (17.1%), scabies (16.5%) and impetigo (15.7%) were the most commonly observed childhood skin diseases and were followed by miliaria (9.8%), eczema (7.1%) and diaper dermatitis (7.0%) respectively. The major predisposing factor to acquiring either tinea infection or scabies or impetigo by any of the affected children was the low socioeconomic conditions of their parents. The high prevalence of eczema in the high social classes could be attributed to the early exposure of the children to artificial milk in infancy. It is hoped that aggressive health educational programmes and improvement of the socioeconomic status of the people will bring about a decline in the prevalence of childhood skin diseases in Nigeria.

Head circumference of rural Nigerian children--the effect of malnutrition on brain growth.

OBJECTIVE: To compare head circumference measurements of the well nourished with those of the malnourished children for each sex. DESIGN: Cross sectional. SETTING: Imesi, Ile-Ife village, Nigeria. SUBJECTS: 644 children in the first six years of life. MAIN OUTCOME MEASURES: Head circumference. RESULTS: The mean head circumference values of malnourished children of both sexes fell mostly below the values for their well nourished age mates. The curve for well nourished girls fell by a little below, and for malnourished girls by over two standard deviations below Tanner's 50th percentile curve. For the boys, the curve for the malnourished children fell by over one standard deviation below the curve for their well nourished age mates. CONCLUSION: The significant reductions in head circumferences found in malnourished children may have serious implications for their future performance and achievement. Therefore, sufficient community concern and appropriate world action aimed at eradicating protein energy malnutrition is solicited.

Secular trends in the growth of children aged 0-6 years in a rural Nigerian community.

Cross-sectional anthropometric measurements were taken between 1987 and 1990 in 673 children aged 0-6 years in Imesi Ile village, Nigeria. The height and weight curves obtained fall behind corresponding growth curves in the same community three decades previously. Mid-upper arm circumference values indicated moderate to severe malnutrition in 25.8% of children aged 1-5 years. The heights of 67.1% and weights of 59.7% of the children fell below the third percentile of a Nigerian equivalent of an international reference population standard. Possible reasons for deterioration of the nutritional status of children in the community include the prevailing adverse socio-economic conditions, changes in child rearing practices over the years, persistence of unsatisfactory living conditions and failure to sustain the implementation of innovative programmes previously introduced into the community. It is suggested that present programmes aimed at promoting the health of rural communities should be reviewed to improve sustainability and should be backed up by measures to improve socio-economic and living conditions.

Delayed sexual maturation in sickle cell anaemia patients--observations in one practice.

Pubic hair and breast appearance ratings, testicular volumes and age at menarche were determined in 24 sickle cell anaemia patients aged from 8.5 to 27 years between February and September 1994 in the Wesley Guild Hospital, Ilesa, Nigeria. Only three of the six females aged 15 or more years had experienced menarche and this was at the mean (SD) age of 18.8 (4.5) years. Public hair appearance and breast development had commenced in only six and seven, respectively, of the 12 females, and in every case the ratings were significantly low for their ages. Male testicular volume was also low for their age in the six of 12 males who were 13 years of age, and above, and pubic hair had appeared in only two of them, aged 20 and 27 years. The height of all the patients was delayed. It is important to recognize that significant delay in sexual development may accompany sickle cell anaemia and to take appropriate steps in managing and counselling the patients.

Anthropometric measurement in children aged 0-6 years in a Nigerian village.

Seven hundred and three Nigerian village children in their first six years of life were subjected to anthropometric measurements and physical examination in early 1988. The heights of 66.9% and weights of 60.5% of them fell below the third percentile of a Nigerian equivalent for international reference population standard. Mid upper arm circumference values indicated moderate to severe malnutrition in over 25% of all 1-5 year old children surveyed. Fever, cough, headache and diarrhoea were the commonest symptoms encountered in the children. Mild pallor of the conjunctival mucosa and physical signs of protein energy malnutrition were commonly seen. Fungal and septic skin lesions were present in 11.45 and 11.1% of the children respectively, whilst rhinorrhoea was seen in 4.7%, otitis media in 6% and pharyngotonsillitis in 3.3%. Thirty four (4.8%) of the children had haemic whereas five had pathological murmurs. Dental calculi were present in 15.8%, umbilical herniae in 18.2%, hepatomegaly in 48.2% and splenomegaly in 23% of the children. Seven (1%) had cerebral palsy. The implication is that malnutrition, sickle cell disease, malaria and other infections are the prevailing causes of morbidity in the preschool aged children surveyed. Desirable improvements include upgrading socio-economic and living conditions and instituting appropriate control measures.

Relapse of tetanus in a child: a case report.

This report concerns the relapse of a case of tetanus which occurred one week after complete cessation of initial symptoms which had taken 4 weeks to nurse. Eventual and lasting resolution of the symptoms followed the removal of a foreign body from the left foot on the 58th day of admission.

The health, growth and educational performance of sickle cell disease children.

In a study by questionnaire and anthropometric measurements of the effect of sickle cell disease on the health growth and education of 102 Nigerian children aged between 9 months and 17 years, the first symptoms of the disease had occurred by the age 1 1/2 years in 58.8% of them. Strenuous exercise and exposure to cold water and weather commonly precipitated illness episodes which occurred in 81.4% of the children at least bi-annually. 94.1% of the children have been hospitalised and 76.5% transfused with blood at least once each before. Of the 67 children in school only 32.8% were in their correct classes and 53.7% have lost years. The mean class examination performance score computed for 55 of those in school was 67.8% +/- 21.5. The heights fall around and the weights below the third percentile of standard growth curves for Nigerian elite children. The disease affects the parameters examined adversely and should be controlled more effectively.

Re-hospitalisation of children in Ilesa

Six hundred and sixty-nine children (419 males and 250 females) readmitted to the Wesley Guild Hospital; Ilesa; over a ten year period were reviewed. The children constituted 2.53of all admission during the period. Over two thirds of the fathers known occupations were in social classes IV and V whilst 90of the children were aged 5 years and below at the time of first hospitalisation which lasted an average period of 7.4 days. Of the total 935 readmissions; 15.4were affected within a month and 70within a year of discharge. Whilst the overall mean number or readmissions per patient was 1.4; it was 2.2 for sicklers; 1.9 for asthmatics and 1.7 for epileptics. Most of the readmissions were unplanned or emergencies and at least 18.7were preventable. The first and repeat admissions were affected more frequently during the rainy than dry season especially for sicklers; asthmatics and malnourished children

Effect of promethazine on the metabolism of chloroquine.

Co-administration of promethazine hydrochloride and chloroquine phosphate resulted in increased blood levels of chloroquine and its metabolites. However, there is no statistical difference between the means obtained for the initial rate of excretion and the total drug excreted within three hours.

The present day epidemiology of severe protein-energy malnutrition in Nigeria.

Eighty-eight patients with severe protein-energy malnutrition (PEM) admitted into the Wesley Guild Hospital, Ilesa, Nigeria over a 9-month period were studied to define the patterns and factors encountered currently in PEM. Severe PEM now occurs predominantly in the 6- to 18-month age group, which is earlier than was reported previously. The majority of the parents were Yoruba Christians and were low-income workers or unemployed. Poverty was a factor in 54.5 percent. Most of the parents were literate. About half of the families were polygamous. The prevalence of social problems was high, with 72.7 percent of the parents living apart. Attacks of measles and recurrent or prolonged gastroenteritis were preceding precipitating factors in 30.7 percent and 33 percent of the patients, respectively. Failure or cessation of breast-feeding or bottle-feeding with cow's milk from the first month of life preceded the development of PEM in a large percentage of patients. The implications of these findings are discussed.

School age pregnancies in western Nigeria: parents and products.

Thirty-three babies and their mothers, all school girls, identified out of a total of 576 admissions to the Paediatric unit of the Wesley Guild Hospital, Ilesa , Nigeria over a three month period were studied. Twenty (60.0%) of the babies were newborn, nine (45%) of whom were premature. Jaundice and infections were other common diagnoses in the neonates. Among the 13 children aged over one month protein-energy malnutrition, gastroenteritis and pneumonia were the commonest reasons for admission. Of the total 33, five (38.5%) had had previous admissions and two (6%) died. Both the numbers of premature neonates and of malnourished older children born to young mothers were significantly higher than those of similar aged admissions born to older mothers (P less than 0.001, in both cases). Thirty-two (97%) mothers were unmarried teenagers and there was a disparity between the academic classes and ages at conception in 15 (45.4%) of the mothers. Whilst significant numbers of the mothers were poorly adjusted to the demands of motherhood, varying numbers of the fathers were young, unemployed, in school and negative in their attitudes to the pregnancies and their products. Suggestions are offered for meeting the challenges posed by school age pregnancy and parenthood in a developing country.